Diagnostic Utility of EMA, Vimentin and CD117 Immunohistochemical Markers in Subtyping Renal Cell Carcinoma in a Nigerian Tertiary Hospital: A 10-year Retrospective Study.

BACKGROUND: Renal cell carcinoma is the most lethal urological cancer and contributes significantly to morbidity and mortality due to cancers of the urogenital tract. In routine diagnostic surgical pathology practice of renal tumours, immunohistochemistry is a helpful ancillary technique after routine H & E. The role of renal immunohistochemistry is explored in this study. MATERIALS AND METHODS: The paraffin-embedded tissue blocks of all the confirmed cases of renal cell carcinoma seen at the University College Hospital (UCH), Ibadan, during the 10-year study period of 2007 to 2016 were retrieved, sectioned and immunohistochemistry done using monoclonal antibodies for EMA, Vimentin and CD117 following standard protocols. Frequency statistics and chi-square were applied to data to determine proportions and associations using the Statistical Package for the Social Sciences (SPSS) version 23. RESULTS: A total of 48 cases of renal cell carcinoma were seen within the study period that met the inclusion criteria for the study. The age range of the patients was between 3 to 76 years with an average age of 44.17 years. The male-to-female ratio was 1:1.3. Fuhrman Grade 2 nuclei were predominant (43.75%) while Fuhrman Grade 4 nuclei had the lowest frequency (6.25%). EMAstaining patterns for the different histological patterns of RCC showed no statistically significant difference while Vimentin and CD117 staining patterns showed a statistically significant difference. There was no statistically significant difference observed between the staining patterns of all three markers and the nuclear grades of the cases of RCC. CONCLUSION: This study demonstrated the usefulness of Vimentin and CD117 in differentiating chromophobe variant of renal cell carcinoma from other subtypes while EMA showed variable expression across the various subtypes.

CONTEXTE: Le carcinome à cellules rénales est le cancer urologique le plus mortel et contribue de manière significative à la morbidité et à la mortalité liées aux cancers du tractus urogénital. Dans la pratique courante de la pathologie chirurgicale diagnostique des tumeurs rénales, l'immunohistochimie est une technique auxiliaire utile après la coloration H & E (hématoxyline et éosine). Le rôle de l'immunohistochimie rénale est exploré dans cette étude. MATÉRIEL ET MÉTHODES: Les blocs de tissus inclus en paraffine de tous les cas confirmés de carcinome à cellules rénales observés à l'hôpital universitaire du collège (UCH) d'Ibadan, au cours de la période d'étude de 10 ans de 2007 à 2016, ont été récupérés, sectionnés et soumis à une immunohistochimie en utilisant des anticorps monoclonaux dirigés contre l'EMA, la vimentine et le CD117 suivant des protocoles standard.Des statistiques de fréquence et le test du chi-carré ont été appliqués aux données pour déterminer les proportions et les associations à l'aide du logiciel Statistical Package for the Social Sciences (SPSS) version 23. RÉSULTATS: Au cours de la période d'étude, un total de 48 cas de carcinome à cellules rénales répondant aux critères d'inclusion de l'étude ont été observés. L'âge des patients variait de 3 à 76 ans, avec un âge moyen de 44,17 ans. Le ratio hommes-femmes était de 1:1,3. Les noyaux de grade Fuhrman 2 étaient prédominants (43,75 %), tandis que les noyaux de grade Fuhrman 4 présentaient la fréquence la plus basse (6,25 %). Les schémas de coloration de l'EMA pour les différentes variantes histologiques du RCC n'ont montré aucune différence statistiquement significative, tandis que les schémas de coloration de la vimentine et du CD117 ont montré une différence statistiquement significative. Aucune différence statistiquement significative n'a été observée entre les schémas de coloration des trois marqueurs et les grades nucléaires des cas de RCC. CONCLUSION: Cette étude a démontré l'utilité de la vimentine et du CD117 pour différencier la variante chromophobe du carcinome à cellules rénales des autres sous-types, tandis que l'EMA a montré une expression variable dans les différents sous-types. Mots-clés: Carcinome à cellules rénales (CCR), antigène membranaire épithélial (EMA), vimentine, C-Kit (tyrosine kinase, CD 117), hématoxyline et éosine (H & E).

Dental Caries, Traumatic Dental Injuries and Gingivitis among Street-Children in Kano, Nigeria.

BACKGROUND: Street-children (Almajirai) constitute a significant proportion of the adolescent population in northern Nigeria. They face health challenges, especially oral health, from being inadequately protected, supervised or directed by responsible adults. OBJECTIVES: The objective of the study was to determine the prevalence of dental caries, dental trauma, gingivitis and oral hygiene scores in street-children. METHODOLOGY: Three hundred and sixty-six school-aged children were selected through a multi-stage sampling of 10 to 12-year-old children from four modern and traditional qur'anic schools, and examined for oral conditions using the WHO protocol. The DMFT index, the modified Ellis criteria, the Gingival Bleeding Index and the Oral Hygiene Index-Simplified (OHI-S) were used to assess dental caries, traumatic dental injuries, gingivitis and oral hygiene scores respectively. Chi-squared tests and Odds Ratio were used to compare the difference and test the association between Almajirai groups. Data analysis was carried out using the Statistical Package for the Social Sciences (SPSS version 20). Statistical significance was considered when p < 0.05. RESULTS: One hundred and sixty eight (45.9%) traditional Almajirai and 198 (59.4%) modern-type Almajirai, participated in the study. Their mean age was 10.8(±0.8) years. The prevalence of dental caries was 25.4% with mean DMFT and SiC scores of 0.6 (±1.3) and 1.7 respectively. DMFT scores ranged from 0 to 12. The prevalence of traumatic dental injuries and gingivitis were 8.7% and 82.2% respectively, while the OHI-S score was 3.0. The odds for traumatic dental injuries were 41% less in the modern-type Almajirai (p=0.02); the modern-type Almajirai were twice as likely to develop gingivitis (aOR 95%CI =2.0, p=0.01). OHI-S scores showed poorer oral hygiene levels in the modern Almajirai (p=0.02). CONCLUSION: Dental caries, traumatic dental injuries, gingivitis and poor oral hygiene were prevalent among street-children in Kano. There is a high level of untreated dental disease in the study population.

CONTEXTE: Les enfants des rues constituent une proportion importante de la population adolescente du nord du Nigeria. Ils sont confrontés à des problèmes de santé, notamment de santé bucco-dentaire, du fait qu'ils ne sont pas suffisamment protégés, supervisés ou dirigés par des adultes responsables. OBJECTIFS: L'objectif de cette étude était de déterminer la prévalence des caries dentaires, des traumatismes dentaires, de la gingivite et des scores d'hygiène buccale chez les enfants des rues. MÉTHODOLOGIE: Trois cent soixante-six enfants d'âge scolaire ont été sélectionnés par un échantillonnage à plusieurs degrés d'enfants de 10 à 12 ans dans quatre écoles qur'aniques modernes et traditionnelles, et ont été examinés pour les conditions bucco-dentaires en utilisant le protocole de l'OMS. L'indice CAOD, les critères d'Ellis modifiés, l'indice de saignement gingival et l'indice d'hygiène buccale simplifié (IOB-S) ont été utilisés pour évaluer les caries dentaires, les lésions dentaires traumatiques, la gingivite et les scores d'hygiène buccale, respectivement. Les tests du chi carré et l'Odds Ratio ont été utilisés pour comparer les différences et tester l'association entre les groupes Almajirai. L'analyse des données a été réalisée à l'aide du progiciel statistique pour les sciences sociales (SPSS version 20). La signification statistique a été considérée lorsque p < 0,05. RÉSULTATS: Cent soixante-huit (45,9%) Almajirai traditionnels et 198 (59,4%) Almajirai de type moderne ont participé à l'étude. Leur âge moyen était de 10,8 (±0,8) ans. La prévalence de la carie dentaire était de 25,4 % avec des scores moyens de CAOD et de SiC de 0,6 (±1,3) et 1,7 respectivement. Les scores CAOD variaient de 0 à 12. La prévalence des lésions dentaires traumatiques et de la gingivite était de 8,7 % et 82,2 % respectivement, tandis que le score OHI-S était de 3,0. Les risques de lésions dentaires traumatiques étaient 41 % moins élevés chez les Almajirai de type moderne (p=0,02) ; les Almajirai de type moderne étaient deux fois plus susceptibles de développer une gingivite (aOR 95%CI =2,0, p=0,01). Les scores OHI-S ont montré des niveaux d'hygiène buccale plus faibles chez les Almajirai de type moderne (p=0,02). CONCLUSION: Les caries dentaires, les lésions dentaires traumatiques, les gingivites et une mauvaise hygiène bucco-dentaire étaient prévalentes chez les enfants des rues de Kano. Il existe un niveau élevé de maladies dentaires non traitées dans la population étudiée. Mots clés: Caries, enfants des rues, Almajirai, Adolescents, Hygiène buccale, Gingivite.

Outcome and surgical management of symptomatic renal angiomyolipoma in Ibadan, Nigeria, Sub-Saharan Africa.

Background: Renal angiomyolipoma is the commonest benign solid kidney neoplasm though rare in clinical practice. The advent of radiological imaging techniques, refinement in surgical approach and techniques and availability of mammalian target of rapamycin have improved the outcome in these cohort of patients. Aim: To report our experience with the surgical management of renal angiomyolipoma in the sub-Saharan Africa. Patients and Methods: This was a retrospective review of the records in the operating theatre book of urology division of patients who underwent radical nephrectomy over a 7-year-period (January 2013 to December 2019). The histologically confirmed renal angiomyolipoma information were retrieved from the records in the Department of Pathology. The clinical data were obtained from the patients' case files by identifying the patient with their registration number and not their names. The clinical features, investigations done, treatment offered, and the outcome of management were recorded in an SPSS version 20. The data was analyzed using statistics of central tendency and percentage. Results: Only 3 females with symptomatic renal angiomyolipoma were managed. This represented 4.9% of 61 patients with solid renal masses managed in the study period. The mean age was 51.2 (ranged 40-70) years. The mean tumor size was 18.9 cm. All the patients underwent radical nephrectomy. The pre- and postoperative urea and creatinine remained normal. The median follow-up period was 21 (16.5-30) months and were asymptomatic. Conclusion: The incidence of renal angiomyolipoma among solid renal masses is 4.9% in our environment. Open radical nephrectomy is still the preferred method of treatment with satisfactory outcome.

The Transgender Phenomenon and its Effect on the Practice of Anatomic Pathology: A Futuristic Perspective.

Introduction of the 'Transgender Phenomenon' "Dave King and Richard Ekins are the leading world sociologists in the field of transgender research. They have put together a brilliant synthesis of history, case studies, ideas and positions as they have emerged over the past thirty years, and bring together a rich and grounded account of this field, providing a state of the art of critical concepts and ideas in this field further during the twenty first century."¹ Based on two decades of fieldwork, life history work, qualitative analysis, archival work and contact with several thousand cross-dressers and sex-changers around the world, these researchers have distinguished a number of contemporary Transgendering 'stories'. 'The assignment of an individual as being of the male or female sex is most often based on the phenotypic appearance of the external genitalia at birth, which is largely determined by the chromosomal type (most commonly 46,XX or 46,XY). Gender identity, however, is an individual's perceived or experienced gender, which may or may not be the same as one's sex assigned at birth. The concept of gender identity includes gradations of masculinity to femininity and maleness to femaleness, as well as identification of some individuals as having nonbinary gender, which means being essentially neither male nor female, or a combination of both. Gender nonconformity is behavioral variation in gender expression (e.g., clothing, mannerisms, accessories, and hairstyles) from cultural and societal norms expected for that gender. Sexual orientation is defined as the physical and emotional attraction of an individual to same-sex people (lesbian or gay; homosexual), both same-sex and opposite-sex people (bisexual), or opposite-sex people (heterosexual).² Transgender is an all-inclusive term that may include all individuals whose gender identity or expression does not align with their assigned birth sex and/or those whose gender identity is outside of the binary male/female classification'.².

Emergency Department Deaths in a Nigerian University Hospital: Deaths Too Many.

OBJECTIVES: We reviewed the demographic pattern and distribution of deaths in the emergency department (ED) of the University College Hospital (UCH) in order to identify gaps in the standard of care, thereby providing evidence for intervention and enhanced research in acute care. METHODS: After obtaining institutional ethics approval, we retrospectively studied all deaths in the ED of UCH from January 1 to December 31, 2011. Data were retrieved from the ED's electronic register. RESULTS: During the 12-month period, a total of 10 728 patients attended the emergency centre and 647 deaths occurred, giving a mortality rate of 6.0%. Male deaths constituted 62% of all deaths. The mean age at death was 44.5 ± 19.1 (range 5 months-92) years. The age group with the highest proportional mortality was 60-69 years (11.4%). Out of all deaths, 295 (45.6%) had alterations of consciousness. Medicine was the specialty with the most deaths (56%), followed by surgery (40%) and lastly, obstetrics and gynaecology (4%). Of the 190 patients that died from trauma, 153 (80.5%) had injury severity score ≥ 15. Most deaths (75.4%) occurred within 24 hours of arrival and the 12-hour night shift had 322 (50%) of the mortalities. Autopsies were carried out in 36 (5.6%) of the 647 deaths. Of the 36 autopsies, 24 (66.7%) were deaths due to medical causes. CONCLUSION: Mortalities within 24 hours of presentation at the ED of UCH remain high. This calls for an efficient pre-hospital care, well-organized emergency transport system, new guidelines, establishment of protocols and regular audit.

Primary ovarian pregnancy mimicking abdominal pregnancy.

The objectives of this study were to emphasise that ectopic pregnancy (EP) can occasionally occur in rare sites such as the ovary, and to show that it may be difficult making the diagnosis clinically and radiologically. It also highlighted the benefit of early surgical intervention in reducing mortality and morbidity from this condition. The case was a 31-year-old nulliparous woman who presented with amenorrhoea of 20 weeks and a 2-month history of lower abdominal pain. Radiological studies suggested abdominal pregnancy coexisting with uterine fibroids for which she had an exploratory laparotomy, which revealed a primary right ovarian pregnancy necessitating the performance of right ovariectomy. Locating the sites of EP may still pose a diagnostic challenge. Despite the benefits and reliability of ultrasound scanning, there will still be situations where the definitive diagnosis can only be confirmed at surgery.

Survival of ovarian cancer patients in Ibadan: clinical and pathological factors.

This retrospective cross-sectional study evaluated the applicability of the universal grading system in a selected patient population and compared the results with the FIGO staging. A total of 49 patients who met the inclusion criteria, were studied. The slides were independently examined by two pathologists, using Silverberg's parameters. The prognostic value of their findings was analysed using Kaplan-Meier graphs. Papillary subtype and abnormal nuclear features were the most frequent histological pattern and a younger age was associated with improved survival. The longest surviving patient (250 weeks) had the lowest mitotic activity, predominantly glandular architecture and little or no nuclear pleomorphism, the reverse is the case for the shortest-term survivor (120 weeks). The universal grading system is useful and comparable with the FIGO staging. The two systems are complementary.

Hepatitis B virus transmission in pre-adolescent schoolchildren in four multi-ethnic areas of England.

The aim of this study was to estimate the amount of childhood hepatitis B virus transmission in children born in the UK, a very low-prevalence country, that is preventable only by universal hepatitis B immunization of infants. Oral fluid specimens were collected from schoolchildren aged 7-11 years in four inner city multi-ethnic areas and tested for the presence of antibody to hepatitis B core antigen (anti-HBc). Those found positive or indeterminate were followed up with testing on serum to confirm their hepatitis B status. The overall prevalence of anti-HBc in children was low [0.26%, 95% confidence interval (CI) 0.14-0.44]. The estimated average annual incidence of hepatitis B was estimated to be 29.26/100 000 children (95% CI 16.00-49.08). The total incidence that is preventable only by a universal infant immunization programme in the UK was estimated to be between 5.00 and 12.49/100 000. The study demonstrates that the extent of horizontal childhood hepatitis B virus transmission is low in children born in the UK and suggests that schools in the UK are an uncommon setting for the transmission of the virus. Targeted hepatitis B testing and immunization of migrants from intermediate- and high-prevalence countries is likely to be a more effective measure to reduce childhood transmission than a universal infant immunization programme.

Renal cell carcinoma in Ibadan: a 5-year clinicopathologic review.

BACKGROUND: To review all the cases of the patients with renal cell carcinoma seen during the study period and to determine the pattern of presentation, number of operable cases, histological types and outcome of treatment. MATERIALS AND METHODS: The data of the patients with renal cell carcinoma was retrieved from the Urology division audit book, theatre record books and case files from the health records department and pathology register in the department of pathology. The parameters studied were age, gender, pattern of presentation, number of patients who had surgery, histology types and the outcome of treatment. RESULTS: In total, there were 69 patients with renal cell carcinoma that accounted for 59.5% of all renal masses seen. The male to female ratio was 1:1. Their age ranged from 16 to 88 with a mean of 48 years and median of 50 years. The main clinical feature was loin swelling (100%) and others were loin pain (29%), hematuria (18.8%), weight loss (4%) and paraneoplastic syndrome (anaemia without haematuria) was seen in 2.9%. Ten percent of the cases had the classical triad of hematuria, loin pain and loin swelling. All cases were unilateral disease and 15 (21.7%) had metastasis at presentation. The pre-operative tests were abdominal ultrasound (94%), intravenous urography (45%) and CT-Scan (11.6%). Twenty eight patients (40.6%) had surgery of which 5 were unresectable. 37 of the patients (53.6%) were subsequently lost to follow-up. The 28 operative specimens were histologically confirmed and 85.7% were clear cell carcinoma. The 23 patients whose tumours were resected have remained symptom free, some up to 5 years. However the five patients with unresectable tumours died between 3 to 6 months of exploratory surgery. CONCLUSION: The patients with resectable tumour could remain disease free for a significant period afterwards despite late presentation. However, there is a high loss to follow-up rate.

CT-guided percutaneous transthoracic lung biopsy: first experience in Ibadan, Nigeria.

Percutaneous lung biopsy had been described in the nineteenth century by Leyden, but image- guided needle chest biopsy only gained widespread acceptance in the 1970s. Currently, tissue sampling of a thoracic lesion is indicated when the diagnosis cannot be obtained by the non-invasive techniques and cytological diagnosis will modify the stage of the disease or influence the therapeutic strategy. Cytology obtained by small-gauge needle aspiration biopsy confirms the nature of the lesion in 80 - 95% of cases and carry a low incidence of major complications. The purpose of this report was to provide information on our first experience with CT-guided biopsy and show that with some innovativeness much can be achieve with limited resources and good team work. We performed a CT of the thorax using appropriately placed improvised metal markers, which determined the optimal cutaneous entry point. We then re-checked the location of the lesion scanning intermittently at 5mm slice thickness; we marked the entry point with a pen and cleaned the surface with methylated spirit. A local anaesthetic was subcutaneously injected around marked area. We used a 21G aspiration needle to obtain cytology sample then 18G Trucut biopsy needle to obtain histology specimen. The length of the needle was chosen based on predetermined distance of the target lesion from the skin estimated from the CT images. Our patient was a 51-year-old Nigerian female with a peripherally located nodule in the posterior aspect of the right lung. She had CT-guided biopsy of the nodule. The procedure was well tolerated with no complication of pneumothorax. The histology report provided the basis for treatment regimen. Our experience indicates that percutaneous transthoracic CT-guided needle biopsy is feasible and a safe procedure in our hospital for evaluation of undetermined lung lesions.

Diagnostic value of lipids, total antioxidants, and trace metals in benign prostate hyperplasia and prostate cancer.

BACKGROUND: Considerable overlap exists in the value of total prostate specific antigen (tPSA) in both prostate cancer (Pca) and benign prostate hyperplasia (BPH). Developing an effective biochemical screening test that will complement PSA assay could reduce the associated cost of care and give timely attention to prostate cancer patients even when they are still asymptomatic is therefore desirable. This work was therefore an attempt to evaluate the possible roles of lipids, antioxidants, and trace metals in breaking the diagnostic tie between Pca and BPH. MATERIALS AND METHODS: Anthropometric characteristics, total prostate specific antigen (tPSA), serum lipids (total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides), Vit. E, total antioxidant status (TAS), and trace metals (Se, Cu, Fe, Zn, and Mn) were determined in 40 patients with histopathological diagnosis of BPH and Pca. Forty age matched control subjects were also recruited from the same community. Informed consent was obtained from all the participants in the study. A P-value < 0.05 was considered significant. RESULTS: There were significant variations in the weight, hip circumference, and body mass index (BMI) across the group but the post hoc test did not show any difference between patients with prostate cancer and BPH. Among the biochemical parameters studied, only the total cholesterol and triglyceride differed significantly between patients with BPH and prostate cancer patients. Cut-offs from ROC for BPH and prostate cancer at 88.9 sensitivity and 66.7% specificity (95% CI) were 88.5 mg and 161 mg/dl for triglycerides and cholesterol respectively. Furthermore there were no significant variations in the mean levels of copper and tPSA, Vit E, and LDL cholesterol among the study subjects and the controls. CONCLUSION: Prior to prostate biopsy, serum lipid (especially, fasting triglycerides, total cholesterol) could help in early discrimination of patients with BPH from prostate cancer in adjunct to total PSA and other management protocol for diagnosis of prostate cancer. The use of trace metal or antioxidants may have limited advantages. Further studies in this regard will be very desirable to see if this pattern of triglyceride and total cholesterol values in BPH and Pca are sustainable.

Preventable trauma deaths in Ibadan: a comparison of revised trauma score and panel review.

BACKGROUND: The proportion of preventable trauma-related deaths may be a reflection of the quality of trauma care in a health institution. OBJECTIVE: To classify mortality in trauma patients in the emergency room and to determine the proportion of preventable trauma related mortality in a teaching hospital. METHODS: The records of patients who died in the emergency room following trauma from January 1996 to December 2005 were reviewed. Data extracted from the patients' records included the demographics, the mechanism of injury; and the duration of injury prior to presentation. The Probability of Survival (Ps) was calculated for each patient using the Revised Trauma Score (RTS). The RTS includes three physiologic parameters namely the Glasgow Coma Score [GCS], systolic blood pressure and respiratory rate which were recorded soon after the patient' presentation at the emergency department. RESULTS: There were 286 patients who died following trauma from January 1996 to December 2006. There was a male: female ratio of 3.4:1. Eighty-one percent were preventable deaths based on the revised trauma score while the panel review considered approximately 22% as preventable. Fifty-nine percent or 168 of the patients arrived in the hospital within six hours of sustaining injury. CONCLUSION: Despite access to emergency care within the first six hours (golden hours) the overall survival of our trauma patients is poor. The severity of the injuries, inadequate resuscitation, and missed injuries by medical personal are some of the factors associated with poor outcome of trauma care.

Pattern of tuberculous lymphadenitis diagnosed by fine needle aspiration cytology at the University College Hospital, Ibadan, Nigeria.

Nigeria currently carries a high burden of tuberculosis, with an associated increasing incidence of extrapulmonary tuberculosis, with the lymph node being one of the most frequently affected sites. This 10 year (1996-2005) retrospective study was carried out to determine the prevalence of tuberculous lymphadenitis in patients at the Fine Needle Aspiration Cytology Clinic of the Department of Pathology, University College Hospital, lbadan, Nigeria. In all, a total of 1,120 lymph node aspirates were examined, out of which 285 (25.45%) were reported as tuberculous lymphadenitis. One hundred and forty-eight (51.9%) were males while 137 (48.1%) were females. The age group of 10-19 years had the highest prevalence of 80 (28.1%), followed by those of 0-9 years with 75 (26.3%) and 20-29 years with 62 (21.8%). The cervical lymph nodes were the most affected sites (63.9%) followed by the supraclavicular (7.7%); submandibular (5.6%); the least affected sites being the clavicular and axillary nodes. The study concludes that tuberculous lymphadenitis is a common clinical presentation in Ibadan and it usually affects children, adolescents and young adults; with the cervical group of lymph nodes being the most commonly affected site.

Intussusception and volvulus secondary to jejunal adenocarcinoma in an adult Nigerian male: a case report.

A 31 year-old Nigerian man with jejuno-jejunal intussusception with the lead point being an adenocarcinoma complicated by small intestinal volvulus is presented. The subtle clinical features of an underlying small bowel malignancy were masked by the overwhelming clinical and radiological features of intussusception. rare case is reported to remind clinicians to have an increased index of suspicion of malignancy in patients who present with the usual features of chronic anemia, weight loss and loss of appetite with an intra-abdominal mass. The presentation of acute intestinal obstruction, with mesenteric vein thrombosis probably due to intussusception or volvulus should not however lower the suspicion. Histological evaluation of surgical biopsies is of immense importance.

BILATERAL GANGLIONIC HAEMORRHAGIC STROKE COMPLICATING SUSPECTED MENINGOCOCCAEMIA: A CASE REPORT.

Haemorrhagic stroke in pyogenic meningitis is a rare complication accounting for about 2% of all complications1,2. It often results from disseminated intravascular coagulation, which is a complication of bacterial meningitis and portends a poor prognosis. A superimposed intracranial haemorrhage, although extremely rare, is associated with high mortality rate. We report a child who had haemorrhagic stroke during the acute phase of bacterial meningitis. The diagnosis was made during post mortem examination. It was discovered that she had suffered haemorrhagic necrosis of both basal ganglion nuclei. Early imaging is advised in meningitis patient presenting with altered levels of consciousness to detect cerebrovascular complications.

Management of splenic injuries in a university teaching hospital in Nigeria.

BACKGROUND: Management of spleen injuries has undergone evolution over the past few decades. OBJECTIVE: To assess the challenges of managing splenic injuries in Nigeria. METHODS: The medical records of all adult trauma patients with documented injury of the spleen over a two-year period (2006-2008) were reviewed. Data collected included patient demographics, mechanism of injury, injury-arrival time, Revised Trauma Score, abdominocentesis, abdominal ultrasound and CT findings. Treatment received, outcome and length of hospital stay were also documented. RESULTS: Twenty-three patients were managed for splenic injuries during the period under review. These consisted of 21 (91.3%) males and two (8.7%) females. The age range was 16 to 58 years [mean of 29.6(12.2 years)]. The mechanism of injury was blunt in 21 cases and penetrating in two cases with motor vehicle accident being the most common cause of injury. The mean injury-arrival time was 25.2(26.5) hours. Eight patients successfully underwent non-operative management, while 15 had operative intervention. Splenectomy was the most frequently performed procedure. Challenges identified in the management of patients with splenic injuries in Nigeria include delayed presentation, underutilization of CT, unavailability of interventional radiology, inadequate ICUs, limited vaccination, discharge against medical advice and poor follow up. CONCLUSION: Non-operative management of injuries to the spleen in adults appears promising. The challenges identified need to be addressed in order to deliver optimal care for the victims of spleen trauma.

Primary malignant bone tumours in Ibadan, Nigeria: an update.

Bone tumours are relatively rare compared to tumours of other sites. The frequency of primary malignant bone tumours is low in our environment, as was observed in an earlier study. The aim of this study is to update the information available on the pattern of primary malignant bone tumours at the University College Hospital (UCH), Ibadan, Nigeria. The medical records of 49 patients with malignant bone tumours documented in the Cancer Registry of UCH, Ibadan between January 2001 and September 2007 were reviewed retrospectively. The results were then added to those of the previous study published in 2002. This brought the number of cases of primary malignant bone tumours to 163 from January 1977 to September 2007. Primary malignant bone tumours represented 0.53% of the 30462 cases of cancer seen in the hospital in the period studied. The male female ratio was 1.5:1. About 44% of the tumours occurred among patients less than 20 years of age. Osteogenic sarcoma was the commonest malignant bone tumour. Important changes recorded in the seven years since the last review from this centre include; a rise in the prevalence rate of primary malignant bone tumours (49 new cases in the last seven years as compared to 114 cases over 23 years), the male-female ratio of Osteogenic sarcoma showed a decline (1.5:1 as compared to 1.6:1), and there was an increase in the prevalence of primary malignant bone tumours in the 0-9 years and > 60 years age groups. The significance of these findings will need to be determined by further studies.

Outcome of trans-anal posterior anorectal myectomy for the ultrashort segment Hirschsprung's disease--Benin City experience in five years.

OBJECTIVE: The conventional treatment of Hirschsprung's disease involves colostomy creation, excision of aganglionic segment, pull through using normally ganglionated proximal bowel segment and colostomy closure. The ultrashort segment variety is treated with posterior anorectal myectomy which requires no prior colostomy creation. This study sought to evaluate the benefits and outcomes of the procedure in a tertiary hospital in Nigeria. PATIENTS AND METHODS: All children diagnosed with ultrashort segment Hirschsprung's disease between January 2003 and December 2007 at the University of Benin Teaching Hospital, Benin City, were prospectively studied. RESULTS: Of 64 children managed with Hirschsprung's disease in five years, 11 (17.2%) were diagnosed with ultrashort segment variety and had posterior anorectal myectomy without prior colostomy. They comprised 7 males and 4 females with male/female ratio 1.8:1 and were aged between 1 month and 9 years (mean 1.5 +/- 0.8 years). The procedure was well tolerated and gave satisfactory results in all the patients as no wound infection or any life threatening morbidity and mortality was recorded. Postoperative pain which responded to paracetamol in the majority of children was statistically significant in older compared to younger patients (P<0.0001). Oral feeds were commenced and tolerated earlier, length of hospitalisation was shorter and no incontinence was recorded unlike the conventional treatment. Also, postoperative nursing care was easier and the single procedure resulted in availability of theatre space for other paediatric operations. All the children did well on 9 months to 4 years follow-up. CONCLUSION: The procedure was found to be beneficial and effective for ultrashort segment Hirschsprung's disease, and should be employed in this subregion.

SECONDARY OVARIAN NEOPLASMS IN A TERTIARY HOSPITAL IN SOUTHWESTERN NIGERIA.

BACKGROUND: The ovary is a common site of involvement for metastases constituting 5-30% of all malignant ovarian neoplasms. Over half of these tumours are bilateral. The commonest sources are stomach, large bowel, appendix, breast, uterus (corpus and cervix) and lung. AIM: The aim of this study was to determine the histopathological pattern of metastases to the ovary at the University College Hospital, Ibadan, Southwestern Nigeria. MATERIAL AND METHODS: This was a retrospective study. All histologically confirmed cases of metastases to the ovary from the records and files of the Department of Pathology, University College Hospital (UCH), Ibadan between January 1991 and June 2013 were used for the study. These were cases diagnosed following total abdominal hysterectomy, total abdominal hystero-salpingooophorectomy, bilateral salpingo-oophorectomy, omentectomy, and multiple peritoneal biopsies and post-mortems at the University College Hospital between January 1991 and June 2013. Cases with inadequate clinical data and whose blocks and or slides could not be retrieved were excluded from the study. The data obtained were analysed using the Statistical Package for Social Sciences version 20. RESULTS: There were 46 cases of metastases to the ovary constituting 5.3% of total ovarian neoplasms. Thirty (63.9%) cases were metastatic carcinomas with the affected patients' age range of 20-79 years, and peak incidence within the age group of 30-39 years. Nineteen out of 30 cases of metastatic carcinomas were from adenocarcinoma of colon, 6 cases were from the gastric carcinoma while the remaining five cases were from the squamous cell carcinoma of the uterine cervix. Fifteen (31.9%) cases of Burkitt Lymphoma were found with patients with age range of 0-39 years, and the peak age of occurrence at the 2nd decade. The only case of metastatic Malignant Mixed Mullerian Tumour and metastatic Leiomyosarcoma were found in the 3rd and 4th decades of life respectively. CONCLUSION: This study has shown that metastases to the ovary occur in younger age groups in our environment. Therefore this study emphasizes that in young females with ovarian masses, the likelihood of metastatic tumours should not be discarded because, correct and precise diagnosis of secondary ovarian malignancy is critical as it has significant implication on the patients' choice of management and prognosis.

Correlation of cervical cytology and visual inspection with acetic acid in HIV-positive women.

The prevalence of squamous intraepithelial lesion is higher among human immunodeficiency virus (HIV)-positive women. These lesions when they occur in these patients are also more difficult to treat. A total of 205 consenting HIV-seropositive women were recruited. A cervical cytology (Pap smear) was taken, followed by visual inspection with freshly prepared 5% acetic acid and cervical biopsy taken from the squamocolumnar junction as the reference for diagnosis to avoid verification bias. The sensitivity of VIA was 76.0% (95% CI 52.0-91.0); specificity 83.0% (95% CI 77.0-88.0); positive predictive value 34.0% (95% CI 21.0-49.0). The sensitivity of cervical cytology (Pap smear) was 57.0% (95% CI 34.0-77.0), specificity of 95.0% (95% CI 90.0-97.0), and positive predictive value of 55.0% (95% CI 33.0-75.0). In HIV-seropositive women, the sensitivity of VIA is 76.0%, making it a useful screening test for preinvasive lesion of the cervix in low resource settings.